Groin exploration with transobturator sling removal: cadaveric and surgical demonstration

Objectives: To demonstrate groin exploration and removal of transobturator mesh.

To review groin anatomy, highlighting critical structures relevant to transobturator mesh placement and removal.

Methods: This video was created from a compilation of two separately recorded surgeries performed at our institution for the same patient. The first was an excision of the vaginal portion of a transobturator sling. The second was of a groin exploration and excision of the groin portion of the transobturator sling. A cadaveric dissection then demonstrates critical anatomy surrounding transobturator mesh removal.

Clinical Relevance: The use of midurethral slings with polypropylene mesh is currently the gold standard surgical treatment for stress urinary incontinence. Surgeons performing this procedure should understand the risks of this surgery and how to identify and manage complications. The incidence of sling revision or removal is approximately 3.7%, with groin pain being a common indication for the revision or removal of transobturator mesh. Surgeons should have a thorough understanding of groin anatomy to be able to perform safe and effective revision or removal of transobturator mesh when indicated. This video demonstrates a technique for groin dissection and review of the relevant anatomy.